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Guide to Co-occurring Disorders & Dual Diagnosis Treatment

Medications are available to individuals struggling with heroin addiction. There are medications that reduce withdrawal symptoms and cravings and those which eliminate signs of opioid intoxication to reverse an overdose.1

The therapeutic community can play a critical role in enhancing outcomes in evidence-based medication-assisted treatment (MAT): combining medications with behavioral therapy can be particularly effective at treating heroin addiction and improving the person’s odds of achieving long-term abstinence.1

However, what if a person has a dual diagnosis and struggles with a mental health disorder that co-occurs with their addiction to heroin?

Treatment for mental illness & heroin addiction

What Is a Co-Occurring Disorder? 

A person with a dual diagnosis has both a mental disorder and a Substance Use Disorder (SUD).2 These conditions frequently co-occur and their interaction is referred to as a co-occurring disorder. It is estimated that approximately one-half of people with a mental disorder will also develop an SUD and vice versa. 

Either of these disorders can develop first and it may be difficult to establish which one developed first.2 Without adequate treatment, both of these conditions tend to worsen.2

When a person struggles with a co-occurring disorder, a comprehensive approach that identifies and evaluates both conditions is needed.2 Treatment-seeking individuals who have dual diagnosis can access integrated treatment programs that can be tailored to their recovery needs while taking into account their co-occurring mental health condition.1

How Does a Person Develop a Co-occurring Disorder? 

A causal relationship between SUD and a mental health disorder may exist. For instance, a person may resort to self-medication through repeated substance abuse to cope with overwhelming symptoms of a mental disorder or when brain changes caused by SUD contribute to the development of a mental disorder.2 

However, this is not necessarily the case, and the two conditions may occur for other reasons that may contribute to both disorders, such as:2

  • Stress.
  • Trauma.
  • Genetics.
  • Other common risk factors.

Which Mental Disorders Can Co-Occur With SUD?

As stated above, co-occurring mental health disorders can be caused by substance abuse, but they can also be independent disorders.2

A co-occurring disorder is a combination of SUD and one or more of the following mental health conditions:3

  • Depressive disorders.
  • Bipolar I disorder.
  • Posttraumatic stress disorder, which is especially common in veterans struggling with substance abuse.
  • Personality disorders.
  • Anxiety disorders.
  • Schizophrenia and other psychotic disorders.
  • Attention deficit hyperactivity disorder.
  • Feeding and eating disorders.

Suicide and trauma are common complications of co-occurring disorders.3

What Are the Signs/Symptoms of Co-Occurring Disorders? 

The common signs/symptoms of a co-occurring disorder include:4 

  • Social isolation and withdrawal from friends and family.
  • Sudden changes in behavior.
  • Engaging in risky behaviors.
  • Developing a high tolerance and withdrawal symptoms.
  • Feeling incapable of functioning without the drug.

Ready to Start Recovery for a Co-occurring Disorder?

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Frequently Asked Questions

How Would Someone with a Mental Health Condition Abuse Heroin?

Although drug use and addiction can happen at any time during a person’s life and whether or not they struggle with a mental disorder, it is during adolescence that individuals are most vulnerable to drug use. This is partly because decision making and impulse control are among the last brain functions to mature.5 

Adolescence is also the time when the first signs of mental illness commonly appear. Having a mental disorder in childhood or adolescence can increase the risk of later drug use and the development of SUD. This may be especially the case if other risk factors are present and the mental health condition is not diagnosed and addressed.5

A 2005 national community survey has found that:6

  • About 8% of respondents with one or more mental health symptoms showed evidence of a co-occurring substance use disorder.
  • The rate of substance use disorder nearly doubled (15%) for respondents with a serious mental disorder.

According to a finding in 2014, 20.2 million adults in the U.S. had a substance use disorder and 7.9 million had both a substance use disorder and another mental illness.7

What Type of Treatment Is Effective for People with a Co-Occurring Disorder?

Comprehensive and supportive treatment of a co-occurring disorder should address both SUDs and the associated mental disorders, with focus on providing continuing care to the recovering individual.3

Once a person with dual diagnosis enters a rehab program, the setting in which detoxification occurs is adjusted accordingly and a comprehensive assessment is performed by factoring in the following:3

  • Whether the person is currently intoxicated and the degree of intoxication.
  • The severity of the withdrawal syndrome.
  • Information regarding past withdrawals.
  • Presence of co-occurring psychiatric, medical, and other conditions which may require specialized care.

Heroin addiction treatment addressing co-occurring disorders is planned on a case-by-case basis, but it typically incorporates some or all of the following common elements:4

It is important to differentiate substance-induced mental disorders from those mental disorders that co-occur with SUDs.3 

Substance-related disorders can be divided into two subcategories:3


SUDs identify the cluster of cognitive, behavioral, and physical symptoms that occur over time as a result of continued and frequent use of substances and as a person progresses to addiction.3

Substance-induced mental disorders

Substance-induced mental disorders refer to intoxication (the immediate effects of substance use), withdrawal (the immediate effects of discontinuing a substance), and other substance-induced mental issues. In the case of abuse of opioids such as heroin, individuals commonly experience anxiety disorders, depressive disorders, and sleep disorders.3

Other substance-induced disorders include:3

  • Substance-induced delirium.
  • Substance-induced persisting dementia.
  • Substance-induced persisting amnestic disorder.
  • Substance-induced psychotic disorder.
  • Substance-induced mood disorder.
  • Hallucinogen persisting perceptual disorder.
  • Substance-induced sexual dysfunction.

Can Heroin Precipitate or Mimic Mental Disorders?

Heroin and other opioids can precipitate or mimic mental disorders in the following way:3

  • During intoxication, heroin can mimic depression and dysthymia, which is a mild but long-term form of depression.
  • During withdrawal, heroin can mimic depression, dysthymia, anxiety disorders, bipolar disorders, and mania.

While intoxication is characterized by intense euphoria and a sense of well-being, withdrawal from heroin, regardless of route of administration, results in agitation, unease, severe body aches, gastrointestinal symptoms, and intense cravings for the drug.3

Symptoms during withdrawal vary widely, with some individuals experiencing acute anxiety and agitation and others struggling with depression and inability to derive pleasure from anything other than heroin.3 

Even if a person maintains abstinence, they may struggle with a protracted withdrawal syndrome characterized by anxiety, depression, and sleep disturbance. These symptoms could persist for weeks.3 

Additionally, these symptoms can be so powerful that the person may relapse even if they are motivated to stay in treatment, which is why MAT can become a potentially life-saving necessity.3

What Are the Benefits of Dual Diagnosis Treatment?

Dual diagnosis treatment can help individuals overcome their co-occurring disorder and keep both their SUD and co-occurring mental disorder under control.3

Individuals with dual diagnosis struggle with complex conditions and may experience demoralization and despair. This is why addiction specialists have a challenging role in developing an appropriate individualized approach and inspiring hope in the recovering individuals.3

Detoxification may be the necessary first step in the recovery process, but the key objective of addiction professionals is to establish and maintain a successful therapeutic relationship with recovering individuals and so increase their chances of long-term recovery.3 

Does Insurance Pay for Dual Diagnosis Treatment?

The Affordable Care Act has made SUD treatment essential under insurance coverage and increased integration and coordination of care across SUD, mental health, and medical care needs.8

This gives treatment-seeking individuals access to affordable treatment which covers the full range of SUD treatment services including detoxification, outpatient treatment, intensive outpatient treatment, residential treatment, recovery support services, and medications.8 

How Does MAT Address Co-occurring Disorders?

Medication-assisted treatment in conjunction with psychosocial treatment is considered the gold standard for SUD treatment.8 Co-occurring disorders are common among people in MAT.9

MAT can address a combination of heroin addiction and a range of mental health disorders, including but not limited to:9

  • Anxiety and mood disorders.
  • Schizophrenia.
  • Bipolar disorder.
  • Major depressive disorder.
  • Conduct disorders.
  • Post-traumatic stress disorder.
  • Attention deficit hyperactivity disorder.

How to Find Treatment for Co-occurring Disorders?

Integrated dual diagnosis treatment is the coordination of heroin abuse and mental health services within a single site or between treatment sites. This integrated approach can address the co-occurring disorder effectively and promote individuals’ chances of achieving long-term success.6Contact a specialized heroin addiction hotline to learn more about options for the treatment of heroin addiction and co-occurring disorders and other valuable addiction treatment and prevention resources available to treatment-seeking individuals.

Let’s verify your coverage for treatment at an American Addiction Centers location. Your information is always confidential.


  1. National Institute on Drug Abuse. (2020). Research Report Series: Heroin.
  2. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts.
  3. Substance Abuse and Mental Health Services Administration. (2012). TIP 42: Substance Use Treatment for Persons With Co-Occurring Disorders.
  4. National Alliance on Mental Illness. (2020). Substance Use Disorders.
  5. National Institute on Drug Abuse. (2020). Part 1: The Connection Between Substance Use Disorders and Mental Illness.
  6. Patrick M. Flynn and Barry S. Brown. (2007). Co-Occurring Disorders in Substance Abuse Treatment: Issues and Prospects
  7. National Institute on Mental Health. (2016). Substance Use and Mental Health
  8. Amanda J. Abraham, Christina M. Andrews, Colleen M. Grogan, Thomas D’Aunno, Keith N. Humphreys, Harold A. Pollack, and Peter D. Friedmann. (2017). The Affordable Care Act Transformation of Substance Use Disorder Treatment.
  9. Substance Abuse and Mental Health Services Administration. (2020). Co-Occurring Disorders and Other Health Conditions.

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